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Utility of Acute Care Urology (ACU) Practice Model in Streamlining Outpatient Stone Treatment
Akshay G. Reddy, MD, Octavia N. Devon, MD, Michelle Kim, MD, PhD, Jeffrey S. Lamont, MD, Marc D. Manganiello, MD.
Massachusetts General Hospital, Boston, MA, USA.
BACKGROUND: The Acute Care Urology (ACU) service was previously described as an innovative practice model implemented to provide comprehensive inpatient and emergency urologic care. Here, we utilize the treatment of ureteral stones as a use-case example to better understand how the service can effectively leverage outpatient resources to improve in-hospital system efficiency.
METHODS: We performed a retrospective review of cases for definitive treatment of ureteral stones with ureteroscopy between August 2024 and February 2025 during outpatient ACU-specific operating room block times. Patients who presented to the emergency department with symptoms of renal colic and found safe for discharge were scheduled at the next available surgery. Cases were performed at the academic medical center or affiliated ambulatory surgical centers (ASC). Length of inpatient stay (LOS) and time from initial consultation to definitive stone treatment were obtained.
RESULTS: There were 91 total ACU cases originating from hospital encounters. 44/91(48%) of cases were performed at ASC and 47/91(52%) at the academic medical center. 51 patients required initial admission, primarily for pain control/hydration with average LOS of 1.43 days. Average time to definitive treatment for all patients was 4.53 days.
Of the 44 patients treated at the ASC, 28 patients were initially discharged from ED without need for admission, 16 were admitted with average LOS of 1.125 days. Average time to treatment was 6.09 days.
CONCLUSIONS: The outpatient ACU operative model provides an expeditious pipeline to definitively manage patients with ureteral calculi and minimizes inpatient hospitalization time. Reducing the often weeks-long wait time for treatment of stones can decrease the rate of admission, likelihood of readmission, need for additional temporizing procedures, and improve patient satisfaction. We continue to accrue data to identify potential operative urologic opportunities for this system to offload the strain on in-hospital care to optimize financial benefits and resource utilization.
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